Chimeric antigen receptor T cell therapy cardiotoxicity: a narrative review

Chimeric antigen receptor (CAR) T cell therapy has transformed the management of some relapsed/refractory hematologic malignancies. However, cardiovascular (CV) toxicity has emerged as a clinically relevant concern, particularly given its increasing use in older patients with CV comorbidities. Cytokine release syndrome (CRS) plays a central role in the development of cardiotoxicity, with interleukin-6 identified as a key mediator. Atrial arrhythmias and heart failure are among the most frequently reported complications. Their management relies on early detection and supportive care, although current strategies are largely extrapolated from general cardio-oncology guidelines. Significant gaps remain in risk stratification, surveillance protocols, and therapeutic approaches tailored to the unique inflammatory profile of CAR T cell-related toxicity. Addressing these gaps is essential to improve CV outcomes in this growing patient population.This narrative review aims to offer clinical cardiologists and hematologists a practical and current framework for the recognition and management of CAR T cell -related cardiotoxicity, with a focus on pathophysiological mechanisms, clinical presentation, and management strategies.